I’m an Iowan, and during the run-up to the caucuses last week, I heard Hillary Clinton on TV speaking to a group of Iowans and exhorting them not to elect someone who would dismantle “successful health-care reform.” “Successful health-care reform”? Mrs. Clinton was speaking to residents in the first state to see their Obamacare exchange go bankrupt – and she’s a candidate from the great state of New York, where the Obamacare exchange is bouncing checks to doctors. What dystopic universe does she live in that she believes in Obamacare’s “success”?

In this first part of a two-part column, I will recap the Obamacare reality now, and in the next installment I will discuss the future and what we must do to save our medical care and save our liberty.

To the surprise of no thinking person, over the last year costs have skyrocketed. Government spending on Medicare has increased more in 2015 than in the first seven years of President Obama’s terms of office. People who previously had coverage have seen their insurance costs go up two and three and in some places fourfold – while accepting higher deductibles. How could it be otherwise when the government is creating a playing field of insecurity and over-regulation? Medicines have become vastly more expensive. Forteo – a bone-promoting injectable that prevents many expensive osteoporotic fractures – in 2011 cost $700/ month if paying cash. Now it is $2,700/month and for Medicare patients $700/month – so basically it is priced out of the reach of patients in need. My old-time thyroid medicine cash price has gone from $10/month to $90/month as have other drugs that have been cheap for decades. Even the veterinarians are feeling it. My local vet decried the price of sedation for animals rising from $8 a vial to over $40.

For people still on “private insurance,” you only have a certain few months of open enrollment to change your carrier. So the insurance companies have a captive audience and can treat them accordingly. Imagine a world in which you only have one restaurant from which to choose, like the Soviet system. How much customer service would you expect? There is no question denial of care was rampant in 2015, especially for pain modalities, spine surgery and a host of other semi-elective items. And, even though you may be paying through the nose, you can’t vote with your feet – because in the land of the free you aren’t free to buy private insurance in July. So you take what they give you – or else.

Of course, Obamacare directly cost millions of full-time jobs as employers scrambled to limit their exposure to IRS penalties by cutting hours and redefining “part time.” Other businesses had to downgrade their employees’ good insurance programs for worse insurance to avoid the “Cadillac” penalty. Although accurate numbers are difficult to come by, according to Matthew Borsch, a senior analyst at Goldman Sachs, while Obamacare exchanges were enrolling people, approximately 6 million people lost their previous coverage – presumably because of cost or change in job description. In the first year of the Obamacare exchanges, 97 percent of the enrollees were added to Medicaid – a program financially unsustainable that offers mediocre medical care and, because of the draconian authorization process, is the most difficult to “access.” Ironically, Obamacare made a point to cancel plans the government determined to be “junk,” while enrolling people into plans that are themselves junk. PPOs, which gave patients choice and paid facilities and doctors reasonable fees to continue to offer services, are disappearing in favor of HMOs, which have a long history of failure to pay the providers, or to really provide coverage for patients in need.

The exchanges themselves are collapsing like a bridge of dominoes. In my state, our Republican governor opted into the Obamacare exchange program, which accepted over $100,000,000 in federal funds, took in millions in premiums and then – before we could say “Solyndra” – collapsed into insolvency. Where did that money go? Inquiring minds want to know. The words “slush fund for political friends” comes to mind.

And private practitioners – me among them – are leaving their offices for other employment: working part-time as a fill-in doctor (locum tenens), working as an employee at a hospital, or completely changing their practice. Now, instead of caring for sick people really in need of medical care – the traditional rold of doctors – more physicians are opting to treat wrinkles with lasers or inject botox. This is happening because insurance and government payments are now so delayed and diminished that doctors can no longer pay their overhead. And the increased complexity and regulatory burden – have done to physicians’ offices what it has done to my local meat markets and dairies – shut them down.

I have not met a physician who believes the Electronic Medical Records (EMR) mandate has made them more efficient. One of my colleagues is a general surgeon who was in private practice with his father – also a general surgeon. Their clinic had been seeing surgical patients for over 50 years but recently was forced to close and sell out to the hospital. As he told me, they couldn’t get paid and couldn’t survive the impact of EMR on their productivity. Added to all this is the personal and professional risk as more and more physicians are being prosecuted for violating federal law. Any billing dispute is now dubbed “fraud.” Federal jail time has recently been meted out for alleged misrepresentation in an operative report. Doctors are opting to become less productive, taking a cut in pay, rather than deal with the hundreds of thousands of potentially punitive regulations. As former Rep. Ernest Istook writes, “Obamacare was designed to be the governmental equivalent of Kudzu – growing everywhere, propagating by multiple means, and sinking its roots and becoming impossible to control.”

Hospitals are struggling because the promised financial benefits of compliance haven’t been realized, but the costs of attempting to march in step with the regulators has been astronomical. Small hospitals and those taking the most Medicaid patients are the most vulnerable. Mercy Hospital in Independence, Kansas, is the 58th rural hospital to close since 2010 under the impact of the health-care reform “success.” And these are the hospitals that give access to the very patients entering the Obamacare exchanges. Doesn’t that conflict with the stated goal? It is a telling point that the Mayo Clinic in Phoenix no longer participates in any government payment program – neither Medicaid nor Medicare.

In good economic fascist form, the government over-regulation sinks small insurance companies, allowing the big ones to operate with less competition. Since Obamacare started, many smaller insurance companies have left the medical market, left certain areas, or gone out of business. Meanwhile, the top five insurance companies have tripled share prices. Even so, United Health Care has announced it will probably leave the Obamacare exchanges in 2017 – and in many states it was the only insurance company that would partake.